5.1.4 Tracheostomy Management

Tracheostomy Management

5.1.4

Version 6.1 March 2024

5.1.4 Tracheostomy Management Contents Preamble ............................................................................................................................. 3 Details .................................................................................................................................. 3 Plan Development ............................................................................................................ 4 Policies and Procedures................................................................................................... 4 Support Worker Training .................................................................................................. 4 Procedure ............................................................................................................................ 5 Summary ............................................................................................................................. 6 Supporting Documents ........................................................................................................ 7 Policies ............................................................................................................................. 7 Forms ............................................................................................................................... 7 Information Sheets ........................................................................................................... 7 NGO Training ................................................................................................................... 7 Legislation ........................................................................................................................ 7 NDIS Practice Standards and Quality Indicators ................................................................. 8 5.1 High Intensity Daily Personal Activities .......................................................................... 8 5.1.4 Tracheostomy Management .................................................................................... 8 Human Services Quality Standards ..................................................................................... 9 3 Responding to Individual Need ..................................................................................... 9 6 Human Resources......................................................................................................... 9 Delegation of Authority......................................................................................................... 9 Version Details ................................................................................................................... 10

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Preamble BigDog Support Services Pty Ltd (BigDog) ensures that each client with a tracheostomy receives appropriate suctioning and management of their tracheostomy relevant and proportionate to their individual needs.

BigDog considers it imperative to involve our clients in all aspects of their service delivery and the direction of their services to their ability. The dignity of risk is an essential part of this choice and control.

It is vital to ensure that support workers care for a tracheostomy tube carefully and thoroughly, as an adverse event such as respiratory distress may develop if the tracheostomy is not managed properly.

Details A tracheostomy is a surgical procedure to cut an opening (stoma) into the trachea (windpipe) so that a tube can be inserted into the opening to assist breathing. A tracheostomy may be temporary or permanent, depending on the reason for its use. For example, if the tracheostomy tube is inserted to bypass a trachea that is blocked by blood or swelling, it will be removed once regular breathing is once again possible.

A client with permanent damage or loss of function around the larynx or swallowing area may need a permanent tracheostomy tube to help them breathe at night. Their speech will be affected as well as eating and drinking.

Tracheostomy may be performed as an emergency procedure to provide relief of blockage of airways above the trachea. This is called an emergency tracheostomy. It involves making a cut in the thin part of the trachea just below the larynx (voice box) and inserting a tube that is connected to a supply of oxygen or air, often using a ventilator (breathing machine).

A non-emergency tracheostomy may be performed for a variety of reasons: for example, before surgery to the throat or mouth so the patient can breathe after the surgery or to make the prolonged use of ventilators more comfortable and safer.

“A tracheotomy may seem scary to some patients, but they’re relatively simple and safe to insert and even easier to remove when no longer needed,” says Saral Mehra, MD, an otolaryngologist (ear, nose and throat specialist) at Yale Medicine.

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Plan Development Each client is involved in the assessment and development of the plan for their tracheostomy suctioning and management. With their consent, the client’s health status is subject to regular and timely review by an appropriately qualified health practitioner. The plan identifies how risks, incidents and emergencies will be managed, including required actions and escalation to ensure client wellbeing.

Policies and Procedures Appropriate policies and procedures are in place, including a training plan for workers, that relate to the support provided to each client with a tracheostomy.

Support Worker Training BigDog will ensure that each worker has completed training, relating specifically to each client’s needs, managing any tracheostomy related incident and high intensity support skills descriptor for providing tracheostomy care (without ventilation) and supporting a client dependent on ventilation, delivered by an appropriately qualified health practitioner or client that meets the high intensity support skills descriptor for tracheostomy suctioning and management.

In the NGO Training course workers will get an in-depth understanding of what tracheostomy support is. They will learn how it works, how to assess and support a client needing a tracheostomy, the different types of tracheostomy procedures and lastly, how to respond to incidents and emergencies.

After this lesson they will be able to: 1. Explain what tracheostomy support is and how it works.

2. Assess and support a client with a tracheostomy.

3. Know how the different procedures to follow when supporting a client with a tracheostomy.

4. Know how to respond to incidents and emergencies.

Course duration: 55 minutes Any other client specific training will be delivered by an appropriately qualified RTO.

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Procedure Tracheostomy Ties 2 workers are required when the ties are changed.

Check and follow the client’s Tracheostomy Support Plan.

Confirm how the client would like to be actively involved in their support, as outlined in their plan, and to their chosen level.

Explain the procedure to the client and seek their consent to proceed.

The tracheostomy is secured using either cotton or Velcro ties. The ties should be changed daily or whenever they become wet.

Changing Ties 1. Moisten 4x4 gauze with saline.

2. Perform hand hygiene and apply non-sterile gloves.

3. Stabilise trach faceplate and carefully unlock inner cannula and remove. Cleanse with saline and soft brush and dry thoroughly or replace with new disposable cannula.

4. Insert clean or new inner cannula and lock into place.

5. Remove old split gauze from around trach. Be careful not to dislodge trach.

6. Hand hygiene/change non-sterile gloves.

7. Assess stoma site for signs of inflammation/infection.

8. Clean around stoma site with moistened saline gauze or sterile tipped cotton applicators. Discard after each wipe. Do not get any gauze fibres in the stoma site!

9. Dry skin around trach site thoroughly with dry sterile 4x4 gauze.

10. Place new split 4x4 gauze under trach.

11. Have a colleague hold trach in place while removing trach ties.

12. Put new ties on, tightening so a maximum of 1–2 fingers can fit under ties.

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Summary If the client has a blocked tracheostomy or the Tracheostomy tube becomes displaced Call 000 IMMEDIATELY and tell the operator that the client has a tracheostomy so specialised paramedics can be sent to assist if available.

Airway Obstruction Secretions could block the tracheostomy tube. Signs of airway obstruction include: Increased respiratory rate.

Altered breathing pattern.

Cyanosis (purple or blue colour around the mouth and nose).

Wheezing.

Agitation or distress Displaced tracheostomy tube (partially or wholly falls out) Remain calm. Call 000 immediately.

Locate the client's emergency tracheostomy bag.

Use the manual resuscitation bag to ventilate the client using the mouth mask until emergency assistance arrives.

Workers cannot reinsert a tracheostomy tube.

Frothy/unusually thick/bloodstained or yellow secretions can indicate an infection or trauma to the trachea.

Any high intensity daily personal activity and management forms part of the formal training program and must be signed off by a Registered Training Organisation (RTO).

Inappropriate tracheostomy management may result in complications such as airway impairment, hypoxia, atelectasis, bradycardia, trauma, and infection. Airway impairment can be life threatening.

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Supporting Documents Policies 1.1 Person-Centred Supports 1.3 Privacy and Dignity 2.3 Quality Management 3.4 Responsive Support 5.1 High Intensity Daily Personal Activities 5.1.6 Ventilator Management

Forms Client Profile Kit NGO Course Report NGO User Report Training Attendance Sheet

Information Sheets Airway Suctioning Passy Muir Valve Tracheostomy Care Plan Checklist Tracheostomy Management Tracheostomy Tubes

NGO Training Tracheostomy Support

Legislation Disability Discrimination Act 1992 (Cwth) Disability Services and Inclusion Act 2023 (Cwth) Disability Services Act 2006 (QLD) Health Act 1937 (QLD) Health Regulation Act 1996 (QLD) National Disability Insurance Scheme Act 2013 NDIS (Provider Registration and Practice Standards) Amendment Rules 2021 Queensland Guardianship and Administration Act 2000 (QLD) Queensland Human Rights Act 2019 (QLD) Queensland Mental Health Act 2016 (QLD)

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NDIS Practice Standards and Quality Indicators BigDog Support Services Pty Ltd (BigDog) is a registered NDIS provider and is required to apply the scheme’s practice standard and quality indicators.

The standards have been developed to create an important benchmark to assess provider performance and ensure that high quality and safe supports and services are provided to NDIS participants.

The four core modules are: 1.0 Rights and Responsibilities; 2.0 Governance and Operational Management; 3.0 The Provision of Supports; and 4.0 The Support Provision Environment.

The supplementary modules cover: 5.0 Specialist Support 5.1 High intensity daily personal activities 5.2 Implementing behaviour support plans.

5.1 High Intensity Daily Personal Activities These NDIS Practice Standards set out the responsibilities of BigDog when providing supports and services to clients that require the following.

5.1.1 Complex Bowel Care 5.1.2 PEG Feeding and Management 5.1.3 Severe Dysphagia Management 5.1.4 Tracheostomy Management 5.1.5 Urinary Catheter Management 5.1.6 Ventilator Management 5.1.7 Subcutaneous Injections 5.1.8 Complex Wound Management

5.1.4 Tracheostomy Management Each participant with a tracheostomy receives appropriate suctioning and management of their tracheostomy relevant and proportionate to their individual needs.

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Human Services Quality Standards The Standards set a benchmark for the quality of service provision. Each Standard is supported by a set of performance indicators which outline what BigDog is required to demonstrate to meet that standard.

3 Responding to Individual Need The assessed needs of the individual are being appropriately addressed and responded to within resource capacity.

3.3 BigDog ensures that services to the individual/s are delivered, monitored, reviewed and reassessed in a timely manner.

6 Human Resources Effective human resource management systems, including recruitment, induction and supervisory processes, result in quality service provision.

6.3 BigDog provides people working in BigDog with induction, training and development opportunities relevant to their roles.

Delegation of Authority Name

Position

Details

Steven Paull

Director

Authorise review and implementation

Courtney Carroll

Director

Authorise review and implementation

David Burrett

Operations Manager

Ensure information dissemination

Monique Paull

HR Manager Lawyer

Ensure compliance by employees

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Version Details This policy will be reviewed every twelve (12) months unless circumstances deem it necessary to review earlier. The review process will involve an analysis of the usefulness of the policy and to note any changes which are required to improve the policy.

If minor changes are made in wording or to clarify the intent, the version number will indicate this by adding a ‘point’ i.e. Version 1.0 indicates the original version and 1.1 with the first round of minor changes made. A significant change or intent of the policy will be indicated by a whole new number i.e. Version 2.0.

The following rules also apply in interpreting this policy: • Headings are for convenience only and do not affect interpretation.

• A singular word includes the plural and vice versa.

• A word that suggests one gender includes the other genders.

Date

V

June 2020

5.0 New Policy

January 2021

5.1 Updated Responsible Officers details

January 2022

5.2 Updated Responsible Offices details and NDIS (Provider Registration and Practice Standards) Amendment Rules 2021

January 2023

6.0 Included Human Services Quality Framework (HSQF) and Child Protection Act and the term “Participant” is returned to “Client” to allow for policies to cover NDIS and HSQF.

March 2024

6.1 Disability Services Act 1986 replaced with Disability Services and Inclusion Act 2023 and policy review process included.

Details

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